The increasing global burden of obesity and its associated comorbidities has created an urgent need for additional treatment options to fight this pandemic.

Our understanding of the mechanisms by which bariatric surgery works has evolved from the initially narrow view that weight loss was largely related to mechanical restriction and malabsorption. It is now evident that anatomic surgical manipulations of the GI tract also result in physiological alterations in gut neuroendocrine signaling, GI motility, autonomic nervous system signaling, bile acid production and absorption, and gut microbiota, all of which contribute to weight loss and to improvement in diabetes.

Emerging endoscopic technologies can reproduce some of the anatomic alterations created during bariatric surgery and are proving to be effective treatments for obesity in selected patients. They additionally offer the potential benefits of reduced invasiveness, reversibility, repeatability, and cost-effectiveness. These advantages may allow endoscopic procedures to be applied to a larger segment of the population with moderate obesity.

In this lecture, Manoel Galvaoprovides an update on endoscopic bariatric therapies, their effectiveness, and how this minimally invasive treatment approach to obesity can increase treatment options beyond surgery, medications, and lifestyle measures..